Rodrigues, A., Wong, C., Mattiussi, A., Alexander, S., Lau, E., & Dupuis, L.L. (2013). Methylnaltrexone for opioid-induced constipation in pediatric oncology patients. Pediatric Blood & Cancer, 60(10), 1667–1670. 

DOI Link

Study Purpose

To determine if methylnaltrexone is an effective treatment for opioid-induced constipation in pediatric patients with cancer

Intervention Characteristics/Basic Study Process

Data were collected from pharmacy records and medical chart reviews. They included demographic data, history of constipation, history of vinca alkaloid use, history of abdominal surgery, history of laxative use and dose, duration of opioid use prior to methylnaltrexone administration, the dose and frequency of methylnaltrexone administration, and the patients' responses to the intervention. Opioid doses were converted to oral morphine equivalents. Bowel regimens were compared to pediatric practice guidelines to determine if the bowel regimen had been optimized prior to administration of methylnaltrexone. Patients were given methylnaltrexone in a single subcutaneous injection. The mean dose was 0.15 ± 0.02 mg/kg per dose (range = 3–12 mg per dose).

Sample Characteristics

  • N = 15  
  • MEDIAN AGE = 14 years (range = 4–17)
  • MALES: 33%, FEMALES: 67%
  • KEY DISEASE CHARACTERISTICS: Sarcoma, lymphoma, and neuroblastoma

Setting

  • SITE: Single-site    
  • SETTING TYPE: Inpatient    
  • LOCATION: Canada

Phase of Care and Clinical Applications

  • APPLICATIONS: Pediatrics

Study Design

Retrospective chart review

Measurement Instruments/Methods

  • Naranjo Adverse Drug Reaction Probability Scale (Naranjo Scale)

Results

Ten patients had a bowel movement within 30 minutes of receiving methylnaltrexone. Four patients had a bowel movement between 30 minutes and 4 hours of administration. Four patients were noted to have decreased abdominal girth and active bowel sounds after the intervention. No patients reported a decrease in pain control.

Conclusions

Methylnaltrexone is one effective intervention to treat opioid-induced constipation for pediatric patients after other interventions have failed. The use of methylnaltrexone to relieve constipation did not lead to an increase in pain for the patients in this study.

Limitations

  • Small sample (< 30)
  • Risk of bias (no control group)
  • Risk of bias (no blinding)
  • Risk of bias (no random assignment) 
  • Risk of bias (no appropriate attentional control condition) 
  • Measurement/methods not well described
  • Other limitations/explanation: Very small sample size; retrospective review

Nursing Implications

Methylnaltrexone should be considered for pediatric patients when other interventions have failed to relieve opioid-induced constipation.